Anxiety Disorders (Phobias)

Anxiety disorders are to do with feelings of fear, apprehension and tension that people experience. Everybody experiences anxiety at some time in their life, a threat will cause a person to be fearful and prepare themselves for the ‘flight or fight’ biological response. However, for some people, the level of anxiety experienced is very high and seriously affects their ability to function properly in everyday life. One common example of an anxiety disorder is phobias.

Symptoms and prevalence of phobias

﻿Definition of a phobia﻿

﻿A phobia is an extreme and irrational fear of an object or situation, which is disproportionate to the actual danger involved, and leads to avoidance of that object or situation. A fear becomes a phobia when it begins to be maladaptive, i.e. when it begins to interfere with everyday life.

SYMPTOMSThe typical symptoms of a phobia are:

Intense and irrational feelings of fear and anxiety, which may be a severe panic attack

Avoidance behaviour, where the person may engage in extreme and complicated behaviours in order to avoid the object or situation that causes panic attacks

Phobias may have a gradual onset or may happen very quickly as a result of a particular experience.﻿

﻿﻿There are three categories of phobia: · Specific phobia – an intense and irrational fear of a particular item or situation, such as animals or places. · Social phobia – a persistent and irrational fear of social situations. Of interacting or performing in front of people. · Agoraphobia – a fear of having a panic attack in a public place. Fear of open spaces.﻿﻿

Download the DSM-IV criteria for the diagnosis of a specific phobia here. Use this sheet to help you with Assignment 1 below.

Assignment 1 - Test your diagnosis

Assignment 2 - Test your memory

a) Define what is meant by the term 'phobia' (2)b) Describe two different types of phobia (4)

Types of phobias

﻿Specific phobia﻿

﻿A specific phobia involves a strong fear and avoidance of a particular object or situation. When exposed to the feared object or situation an individual will experience great anxiety, a panic reaction often occurs and the situation or object is usually avoided. Sometimes simply anticipating exposure to the feared object can bring on a panic attack. In addition to the points above, to be diagnosed with a specific phobia the fear must:

Be triggered immediately on exposure to the object or situation

Specific phobias are quite common, affecting 10% of the population, and are more prevalent in women than in men. Fear of dogs might be one common example.Fear of blood is different from other specific phobias as the person may actually faint at the sight of blood and may therefore avoid seeking medical attention.﻿

Social phobia

Fear of social situations. The high levels of anxiety or panic can result in the person performing poorly in front of others. In an interview situation, for example, the person may perform so poorly that they are not offered the job. People with social phobias are often very able, but do not demonstrate this in front of others because the anxiety is so debilitating. Often the anxiety is so strong that it causes avoidance of certain situations altogether. When the social anxiety interferes with work and social life it becomes a clinical condition. Generally people with social phobia feel inadequate in comparison to other people and find relationships difficult. To compensate they may become workaholics or develop all-consuming hobbies. Social phobias occur more in women than men often starting during adolescence and seem to be more common in families where parents and relatives use shame as a way of controlling a child’s behaviour. Social phobias are NOT just "shyness", they are far more.

Agoraphobia

Agoraphobia is a particular fear of 'situations where escape would be difficult', often represented as a fear of open spaces. Approximately 2-3% of the population suffer from agoraphobia and the majority are women. Research has shown that agoraphobia develops as a result of severe panic attacks that the person does not expect to happen (Barlow 2002). There are two types of agoraphobia:1. Agoraphobia as a complication of panic attacks. Agoraphobics are anxious about having a panic attack in a public place and being unable to escape or find help. The person then engages in avoidance behaviour, which results in staying at home, not going outside and becoming fearful at the simple thought of going out. 2. Agoraphobia without panic attacks. This is less common than the above type, and is characterised by a spreading fear of the environment outside the safety of the individual’s own home. This fear gradually increases in severity, until eventually the person can become housebound.

Examples of phobias

Below are a couple of case studies of people with phobias. In both cases, you can start to see some possible treatment methods for the phobias too... Make sure you can pick out the features of these cases which make them a phobia (rather than just a fear). How do they match the criteria given above?

Prevalence of phobias - Fredrikson et al (1996)

Point prevalence of specific fears and phobias was determined in 704 respondents of 1000 randomly selected adults aged 18–70 yr. A phobia for lightning, enclosed spaces, darkness, flying, heights, spiders, snakes, injections, dentists and/or injuries was defined if subjects reported a fear that was out of conscious control, interfered with life and lead to the avoidance of the feared object [American Psychiatric Association, 1994. Diagnostic and statistical manual of mental disorders (4th edn). Washington, DC: American Psychiatric Press.] Fear intensity was assessed using visual analogue scales. A factor analysis generally supported the classification of fears and phobias into: (1) situational phobias (lightning, enclosed spaces, darkness, flying and heights); (2) animal phobias (spiders and snakes); and (3) mutilation phobias (injections, dentists, injuries). Total point prevalence of any specific phobia was 19.9% (26.5% for females and 12.4% for males). In total, 21.2% women and 10.9% men met criterias for any single specific phobia. Multiple phobias was reported by 5.4% of the females and 1.5% of the males. Animal phobia had a prevalence of 12.1% in women and 3.3% in men. Point prevalence of situational phobia was 17.4% in women and 8.5% in men. For mutilation phobia no gender difference was observed, being presented in 3.2% of the women and 2.7% of the men. Women as compared to men gave higher fear ratings for all objects and situations. Inanimate object fears and phobias were more common in older than younger individuals. Animal fears were more intense in younger than in older individuals. Fear of flying increased and fear of injections decreased as a function of age in women but not in men. Thus, specific fears and phobias are heterogeneous with respect to sex and age distribution.

Assignment 3 - analysing research

Look at the abstract of the paper by Fredrikson et al (1996) to the left (conducted in Sweden).

Write three conclusions that you can draw from the study regarding the prevalence of phobias.

Assignment 4 - Cross-cultural triangulation - Chapman et al (2008)

Look at this research summary of phobias in African Americans and Caucasian Americans from Chapman et al (2008). What similarities and differences do you see? Is there anything here which would link to some of the discussions that we had in the 'Concepts and Diagnosis' section?

Write two similarities and two differences of the results here with the results of Fredrikson et al.

Chapman et al concluded:

"The African American sample-endorsed fears related to the natural environment, animals, and social anxiety. The CaucasianAmerican sample-endorsed fears related to circumscribed situations, animals, and social anxiety. Although the two samples were similar in two factors of specific phobia domains (i.e., animals and social anxiety), there were significantly different patterns in the items endorsed by the two samples. Overall, these results suggest that African Americans in the current sample endorsed a greater number of fears than the Caucasian American sample and that some disparities exist in the patterns of phobia domains among these two racial groups.

Etiologies of phobias

﻿Biomedical/Genetic explanations for phobias﻿

﻿Some people seem more susceptible to developing a phobia than others, and therefore a genetic explanation has been proposed to account for these individual differences.

Before you read any further, ASK YOURSELF "What sorts of methods would be used to investigate the genetic basis of phobias?" Based on what you already know from other biological and genetic explanations, you should be able to suggest this in detail already...﻿

﻿Some initial biological evidence - Ost (1992)﻿

J Abnorm Psychol. 1992 Feb;101(1):68-74.Blood and injection phobia: background and cognitive, physiological, and behavioral variables.Ost LG.Author information﻿Abstract: Blood-phobic (n = 81) and injection-phobic (n = 59) patients fulfilling the DSM-III-R criteria for simple phobia were compared on a number of variables. There were no differences between the samples in age at onset, age at treatment, marital and occupational status, history of fainting in the phobic situation, and impairment. Higher proportions of blood-phobic subjects than of injection-phobic subjects reported having first-degree relatives with the same phobia (61% vs. 29%) and reported fearing that they were going to faint in the phobic situation (77% vs. 48%). In b﻿oth samples, these proportions were higher in the subgroup with a history of fainting. Overall 62% of people with a blood and injection phobia reported a 1st-degree relative who shares the same disorder. The prevalence rate for the general population is just 3%. Injection-phobic subjects rated 2 of 11 physiological items higher than did blood-phobics subjects, but the groups did not differ on behavioral variables. Overall, the similarities were more marked than the differences, and it is suggested that these two specific phobias should be regarded as one diagnostic entity. ﻿

Ost (1992) investigated blood and needle phobias

Assignment 6 - summarising research

Read the abstract of the paper by Ost (1992), and produce a summary of the main findings. Then write three conclusions that could be drawn from the research, and three evaluations of it.

'Preparedness' might explain why we see this harmless bit of rope as a snake...

﻿How does the biological explanation work? - Preparedness﻿

﻿The 'preparedness explanation suggests that human beings have a genetic predisposition to develop phobias to certain items and situations, such as fear of darkness, heights open spaces and strangers. These were potential sources of danger to us thousands of years ago. Those individuals who developed such phobias would avoid harmful objects or situations and would be favoured by evolution. Seligman (1971) suggested that there was a ‘preparedness’ (a physiological predisposition) to be sensitive to certain stimuli. It is not the fears themselves that are inborn, rather there is an innate (in-born) tendency to rapidly acquire a phobia to potentially harmful events – we are biologically prepared from birth.﻿

﻿Preparedness - a happy marriage of biology and environmental factors﻿

﻿Preparedness can be explained equally well from a biological and behaviourist perspectives:

Biological – a readiness to fear certain things could have evolved and then been passed ongenetically

Behaviourist – experience with certain animals, such as snakes or spiders, might have taught us to fear them and in some cases develop a phobia.

On other words, we are genetically programmed to develop classically conditioned phobias more rapidly to certain objects!﻿

It's common to use different approaches as though they are rivals - but that doesn't always have to be the case. They can work well together too!

﻿Evidence for preparedness - Ohman et al (1975)﻿

﻿AIM Conducted a series of studies to investigate the preparedness explanation of phobia acquisitionMETHOD Participants were shown pictures of houses, snakes, spiders and faces of people. Half the participants received an electric shock whenever they were presented with a picture of a house or a face. The other half received an electric shock whenever they were presented with a picture of a snake or spider.RESULTS Both groups of Pp’s showed fear when subsequently shown pictures they had experienced with an electric shock. This was measured by their skin reaction called galvanic skin response (GSR). Following a period in which Pp’s received no electric shocks it was found that the GSR was higher for those shocked when shown snakes and spiders.CONCLUSION Human beings may be more biologically prepared or read﻿y to develop phobias for animals such as snakes and spiders, which may threaten survival.﻿

﻿Evaluating biological explanations for phobias﻿

GENETIC STUDIES:

﻿You already know the potential problems with twin and family studies! They're the same here. Write a short summary of these evaluations, applying them specifically to the research given here on phobias.﻿

PREPAREDNESS:

﻿Supported by experimental evidence in humans as well as in animal studies. Also, because it uses aspects of both behaviourist and biological ideas, it is a more holistic explanation for the formation of phobias.﻿

﻿The studies on prepared fears have been criticised because there is evidence that the fears acquired under laboratory conditions are easily removed simply by verbal instructions, and therefore these laboratory fears are unlike phobias that people would acquire in the real world - they are not ecologically valid phobias.﻿

Could you have predicted these criticisms? The same issues come up time and time again! The better you understand this, the better you'll do in an exam!

﻿Cognitive explanations for phobias﻿

﻿As you know, in cognitive explanations the fearful response is experienced due to the interpretation or appraisal of events. It is the interpretation of an event that triggers the emotion not the event itself.

When a person has a phobia, their response to a situation/object is immediate and extreme, and the interpretation and appraisal distorted. Phobias form and persist due to three main factors:﻿

Sensitisation

The sufferer becomes unusually 'sensitive' to an object. Anxiety becomes associated with a particular object/situation so that the presence of (or thinking about) it is enough to automatically trigger anxiety.

They may also be hypersensitive to their own body's anxious responses - e.g. their breathing or heart rate. This has been described as cognitive vulnerability (Clark, 1996).

﻿Avoidance﻿

﻿After sensitisation occurs a person will avoid an object/situation and this becomes rewarding because the anxiety decreases.﻿

Irrational or negative thought processes

Over-estimating a negative outcome – ‘what if the snake bites me and is poisonous’

Catastrophising – ‘There would be antidote and I would be disabled or die’

Under-estimating ability to cope – ‘I’d never be able to cope in a wheelchair’

﻿Example of a case study for cognitive explanations - agoraphobia﻿

﻿According to cognitive theory, the agoraphobic person is hypersensitive to spatial layouts in the environment and also to being too far away from a someone who could take care of them. If access to home or the caretaker is blocked then fear is induced and the agoraphobic has an urgent need to return home. They may catastrophise what can happen in open or crowded spaces (e.g. "what if one of these people attacks me?"), or over-estimate the danger they are in ("there's nowhere here that's safe"). As a result of this, the person might begin to avoid open spaces, becoming house-bound and rarely going outside.

Beck et al (1985) proposes that agoraphobics possess latent fears of situations that might have been potentially dangerous to a child but are not dangerous toadults, for example, crowded shops or open spaces. This explains the sensitisation.﻿

Here is another study which nicely illustrates the idea of cognitive vulnerability

﻿Research supporting the cognitive approach - Di Nardo et al (1988)﻿

﻿DiNardo et al. (1988) reported that 56% of dog phobics had an unpleasant encounter but about 50% of normal controls had also had such experiences and did not develop a phobia. Behaviourism ignores cognitive factors and so cannot account for individual variation. The fact that not all phobics have had a bad experience and s﻿ome non-phobics have had a bad experience and not developed phobia is probably due to the patients’ perception and interpretation, and so cognitive rather than behavioural factors are important.﻿

﻿Evaluation of cognitive explanations of phobias﻿

They accept the acquisition of fear through learning, for example, conditioning, but also emphasis the person’s own interpretation of events. They therefore present a more holistic explanation than some others.

The cognitive explanation is a coherent theory with practical therapeutic applications. The treatments have proved highly effective for anxiety disorders such as phobias. The success of the treatments supports the explanation.

Psychologists can conduct experiments to identify the different though processes of those who have a phobia and those who do not. This makes the explanation scientific and objective.

BUT behaviour is not always driven by cognitions, evidence suggests that cognitions can be driven and/or maintained by inappropriate behaviour such as avoidance. Therefore behaviourist ideas may sometimes be more effective for explaining a phobia.

﻿﻿Sociocultural explanations for phobias﻿﻿

There is little doubt that the environment has a large impact on our phobias (look at the DiNardo et al 1988 study above for example - over 50% of phobias could be clearly traced to a traumatic event)... but the specific impact of the social and cultural surroundings on phobias is less clear. There is not as much research in this area as for biological explanations, for example

﻿Social learning theory and phobias﻿

This might be an example of how SLT could help to treat a phobia, as well as to create one... Picture from Education Portal. Click to visit

Remember SLT from Bandura's experiment...? Recap here if not Phobias could develop as a result of watching/observing another person (the model) experience the pain/upset from an object/situation. If the observer is a young child, the model may be the mother or father. This is sometimes called vicarious learning. Mineka and Cook (1986) found that lab-born monkeys with no fear of snakes could vicariously learn to be afraid of them if they were in the presenc﻿e of wild-born monkeys (who were afraid).

﻿"The research confirmed that, whereas observer monkeys did not initially show fear to any of the stimuli, after 12 sessions they had acquired fear of evolutionarily relevant stimuli but not of non-evolutionarily relevant stimuli (pictures and shapes etc)."﻿

Cultural differences in phobias

This should look familiar... as we've already looked at some cross-cultural phobia evidence in the 'prevalence' section.

Look back at the studies by Fredrikson et al (1996) and Chapman et al (2008). How do these illustrate a sociocultural aspect to anxiety disorders?

Assignment 7 - ERQ

Plan and answer the following question (about phobias). Aim to write the answer in under 1 hour, using only the plan that you've made.

Analyse etiologies of one disorder (22)

Implementing treatments for phobias

Biomedical treatments for phobias

Biomedical therapies are very rarely used in isolation for phobias. Usually they will only be used as a last resort after other psychological treatments have failed, and even then they will almost always be used in combination with another treatment (such as CBT). It is important that you understand that these are not the first choice therapy in the vast majority of cases.

Benzodiazepine tranquillisers

Specific phobias can produce intense anxiety, so one of the functions of some drug therapies is to reduce this anxiety using tranquillising, sedative drugs. These enhance the effectiveness of GABA, the main inhibitory neurotransmitter. One example of these drugs is alprazolam (Xanax).

Two major issues for the use of benzodiazepines are:

Side-effects, which can be significant and can include increased tolerance and addiction, drowsiness, sexual problems, aggression and irritability.

The treatment-aetiology fallacy. They treat the symptoms not the cause, so the underlying phobia is not cured by the drugs... so the phobia will recur when the drugs wear off. This is in contrast to psychological therapies, which attempt to treat the cause of the phobia at source.

SSRI anti-depressants

Benjamin et al (2008) conducted a randomised, placebo-controlled trial with 11 patients who were given 20mg per day of either paroxetine (an SSRI) or a placebo. They found significant improvements in the paroxetine group.

Can you evaluate this study? What conclusions (if any) can we draw from it)?

Individual therapies for phobias﻿

There are two commonly used forms of individual treatment for phobias; behaviourist and cognitive therapies. These are often used in conjunction with each other, and many modern therapy methods incorporate aspects of both. One of the interesting findings of research into individual treatments for phobias is that different phobias respond well to different types of treatment! For example, whilst many phobias seem to respond well to in vivo exposure (see below), claustrophobia seems better treated by cognitive therapy and virtual reality exposure therapy (VRET - see below) may be more effective for heights and flying phobias. See this review by Choy et al (2007) for these and other conclusions.

Behaviourist therapies

﻿Remember that behaviourists would explain phobias as a learned association between a certain stimulus (e.g. dogs) and a certain response (e.g. fear). Behaviourist therapies will therefore try﻿ to reduce the strength of these associations. There are two main methods used to try to do this﻿

﻿Systematic desensitisation (in vivo exposure)﻿

﻿This involves the gradual exposure of the sufferer to the phobic object.

Developed by Wolpe (1958) it is based on the idea that two emotions cannot occur at the same time. There are 2 key aspects to this technique:• Getting people to practise relaxation techniques when feelings of tension and anxiety arise• A stepped approach to getting the person to face the object or situation of their phobia (a hierarchy).

e.g. The top of the hierarchy might be touching the phobic object, whereas the bottom of the hierarchy might be having one in the same room. Slowly, the object can be moved through the hierarchy until the fear can be replaced with relaxation.

﻿Virtual reality exposure therapy (VRET)﻿

﻿This is a new technique based on the principles of systematic desensitisation, but the therapy takes place in a virtual world. Although used largely to date with phobic patients, it is being trialled with other anxiety disorders too.

﻿Patients are placed in a 3-dimensional virtual world where they wear a head mounted display which allows the individual to pick up sensory cues. A computer monitor shows the therapist wha﻿t t﻿he patient sees. This video shows it in action for arachnophobia. However, as this is quite an expensive technique to perform... it makes more sense to use it for more costly phobias such as aviophobia (fear of flying).It seems most effective for fears of flying and heights.﻿﻿

﻿Flooding﻿

﻿This involves a sudden, overweening exposure to the phobic object; overwhelming the individual’s senses with the item or situation that causes anxiety so that the person realises that no harm will occur and in fact there is no objective basis for their fear.The steps that are involved in this are:1. A patient is exposed to the object/situation that causes anxiety (e.g. a room full of snakes)2. The patient is initially overwhelmed and very fearful, but this subsides after a while3. The patient recognises that anxiety levels have dropped and that although such situations have been avoided in the past, there is in fact no reason for this.

The video above shows this process:﻿

Gary Larson's wonderful take on flooding...

﻿Systematic desensitisation can also be performed in the patient's imagination. As you might expect, the results for this version of the therapy do not tend to be as strong as for in vivo exposure.﻿

﻿Evaluating behavioura﻿l therapies for phobias﻿

Systematic desensitisation is supported by empirical evidence, which shows it often be an effective treatment for specific phobias (e.g. Lang and Lazovik).

Systematic desensitisation works well in the therapeutic situation and is a quick and cost effective method. However the therapeutic effect does not always generalise to the patient’s everyday life (as real life is not as controlled as the therapy).

Choy et al (2007) found that systematic desensitisation was effective at reducing anxiety levels, but less so at preventing avoidance behaviour.

In vivo (real-life exposure) is more effective that in vitro (imagined exposure) for both flooding and systematic desensitisation.

VRET has advantages over systematic desensitisation as it is much easier and cheaper and often more convenient, but still has a similar level of success.﻿

﻿The equipment required for VRET is expensive and may not be suitable for all phobias. In addition patients do sometimes report negative side-effects e.g. nausea﻿

Systematic desensitisation can only be used when a particular phobic object/situation can be identified. It is suitable for phobias of snakes/spiders etc but not for generalised social phobias, so it is only useful for certain cases.

Flooding produces high levels of fear and this can be very traumatic, and therefore has ethical implications.

﻿Group therapy for phobias﻿

Cognitive Behavioral Group Therapy for Social Phobia

﻿You know by know that the aim of cognitive therapy will be to replace unrealistic and fearful thinking about phobias with more realistic mental habits. It teaches patients to identify, challenge and replace counter-productive thoughts with more constructive thinking patterns. The task is to get the client to see that their thoughts are irrational and not based in reality.﻿

Group therapy sessions provide the same CBT structure and activities, but in a group setting. Interestingly, group therapy seems more effective (and is more widely used) for social phobia than for specific phobias.

Description of the treatment

The following is taken from: Juster, H.R., & Heimberg, R.G. (1994). Cognitive behavioral group therapy for social phobia. The Clinical Psychologist, 47, 18-20.Full text can be read here.

Cognitive restructuring/exposure exercises constitute the bulk of the CBGT session. For each targeted client, a period of cognitive restructuring precedes a simulated exposure to a feared situation. Setup procedures prior to the exposure consist of:

identification of automatic negative thoughts (ATs) that the client reports in anticipation of the situation,

classification of ATs using a typology of cognitive distortions adapted from Burns (1980) and Persons (1989),

disputation of ATs through repeated questioning and challenging of the underlying assumptions, and

development of alternative responses that are rational, cue the client regarding the disputation process just completed, and aid the client in remaining task-focused.

Jack Sparrow knows all about CBT...

﻿Cognitive rehearsal﻿

﻿Cognitive rehearsal helps the individual to think about and mentally rehearse appropriate behaviours, so that when it comes to the real thing these behaviours can be enacted. It helps to stop the person thinking about the negatives.

For example, in social phobia a client is asked to think about specific behaviours that are appropriate to the social situation, they then rehearse the appropriate behaviours to perform. For example clearly introducing themselves and saying what the topic of the presentation is, referring to notes when the different slides come up, looking at the audience and asking if anyone has any questions at the end of the presentation. When it comes to the actual presentation the client enacts these behaviours.

﻿Challenging distorted thinking often also involves using counterstatements.﻿

﻿Using Counterstatements﻿

Examples of counterstatements for some of the common cognitive distortions associated with phobias. Click to enlarge.

﻿Key study - Wersebe et al (2013)﻿

Background: A few meta-analyses have examined psychological treatments for a social anxiety disorder (SAD). This is the first meta-analysis that examines the effects of cognitive behavioural group therapies (CBGT) for SAD compared to control on symptoms of anxiety.Method: After a systematic literature search in PubMed, Cochrane, PsychINFO and Embase was conducted; eleven studies were identified that met the inclusion criteria. The studies had to be randomized controlled studies in which individuals with a diagnosed SAD were treated with cognitive-behavioural group therapy (CBGT) and compared with a control group. The overall quality of the studies was moderate.Results: The pooled effect size indicated that the difference between intervention and control conditions was 0.53 (96% CI: 0.33–0.73), in favour of the intervention. This corresponds to a NNT 3.24. Heterogeneity was low to moderately high in all analyses. There was some indication of publication bias.Conclusions: It was found that psychological group-treatments CBGT are more effective than control conditions in patients with SAD. Since heterogeneity between studies was high, more research comparing group psychotherapies for SAD to control is needed.

Assignment 7

Write half a page summarising the main findings of Wersebe at al's study. Can you think of any evaluation points which could be raised about the study or the conclusions? Once you've thought of your own, this article may help to suggest some more.

Evaluating cognitive group therapies

﻿There is a lot of empirical evidence to support cognitive therapy for social phobias (e.g. Wersebe et al, 2013).

Patients may be less likely to relapse than those given biological treatments as they are being given the skills to self-manage their condition (which drugs don't provide)﻿

Group therapy is much cheaper and less time consuming than individual therapies, as numerous people can receive therapy together.

﻿Although we know that CBTs are often effective, it is not clear whether the cognitive or the behavioural aspect are the most important in the improvement. It could be that behavioural factors are causing the improvement.

Although changes in patients’ cognitions must take place during cognitive therapy, it is not clear what element of the therapy is most effective. It might be that any cognitive change is a consequence of some other factor (e.g. medication or lifestyle change) and not the intervention by the therapist.﻿

Stangier et al (2003) compared group CBT to individual CBT and found that it was less effective, suggesting that although group therapy may be cost-effective it may not be the best option for effective treatment.

Questions using both conditions

Now that we've finished both abnormality conditions, you can begin to plan answers to questions which could ask you for an understanding of both of them. E.g.:

You should be able to write at least a page from memory on the different suggested etiologies of each condition. Revise these, then practise doing this!

22 mark Extended Response Questions

The 4 possible essay questions for this section (though remember that the command terms could change) are:

• Examine biomedical, individual and group approaches to treatment.• Evaluate the use of biomedical, individual and group approaches to the treatment of one disorder.• Discuss the use of eclectic approaches to treatment.• Discuss the relationship between etiology and therapeutic approach in relation to one disorder.

NOTE HOW MUCH ALL OF THESE ESSAYS WILL OVERLAP! THE SAME INFORMATION CAN BE USED, REGARDLESS OF THE TITLE OF THE ESSAY (AS LONG AS YOU REMEMBER TO ANSWER THE QUESTION)

You should plan an essay which will be about 2-3 sides of A4 long, including a detailed focus on the command term.

The marking criteria are below. ALWAYS refer to these before you begin to plan your essay. It is crucial that you know what the examiners are looking for so that you can write exactly what is needed for top marks!

Planning a great 22 mark question

KNOW THE COMMAND TERM! This is absolutely crucial! A different command term requires a different style of essay, so you need to tailor what you write to the question. You will still be able to use the same pieces of information, but how you use them may vary.

PLAN PLAN PLAN! Every year the examiners' comments mention that essays which are clearly planned score the best marks. FOLLOW THEIR ADVICE! Don't be afraid to spend up to 10 minutes in an exam planning your essay (and longer earlier in the year when are learning and practising).

USE EVIDENCE! You have 2 detailed studies here to use, but you should also look to find triangulating evidence using other experimental methods or from other areas of the syllabus

EVALUATE! You must evaluate the studies you present. Evaluating means talking about the strengths and weaknesses of the study as well as the strengths and weaknesses of the level of analysis as a whole with reference to the question (e.g. reductionist explanation of genetics in some behaviour)